TY - JOUR
T1 - Endovascular Treatment and Peri-interventional Management of Ruptured Cerebrovascular Lesions During Pregnancy
T2 - Case Series and Case-based Systematic Review
AU - Etter, Manina M.
AU - Nguyen, Anh
AU - Brehm, Alex
AU - Aberle, Christoph
AU - Tsogkas, Ioannis
AU - Guzman, Raphael
AU - Dmytriw, Adam A.
AU - Parra-Farinas, Carmen
AU - Mascitelli, Justin R.
AU - Pereira, Vitor Mendes
AU - Starke, Robert M.
AU - Fragata, Isabel
AU - Reis, João
AU - Wolfe, Stacey Quintero
AU - Porto, Guilherme B.
AU - Spiotta, Alejandro M.
AU - Psychogios, Marios Nikos
N1 - Publisher Copyright:
© 2023, The Author(s).
PY - 2023/9
Y1 - 2023/9
N2 - Purpose: Hemorrhagic stroke, particularly occurring from ruptured cerebrovascular malformations, is responsible for 5–12% of all maternal deaths during pregnancy and the puerperium. Whether endovascular treatment is feasible and safe for both the mother and the fetus, is still a matter of debate. The main objective of this case series and systematic review was to share our multi-institutional experience and to assess the feasibility and safety of endovascular treatment during pregnancy, as well as the corresponding maternal and fetal outcomes based on currently available evidence. Methods: We report a case series of 12 pregnant women presenting with hemorrhagic stroke from ruptured cerebrovascular arteriovenous malformations or aneurysms who underwent endovascular treatment prior to delivery. A systematic literature review of pregnant patients with endovascular treated cerebrovascular malformations, published between 1995 and 2022, was performed. Clinical patient information, detailed treatment strategies, maternal and fetal outcomes as well as information on the delivery were collected and assessed. Results: In most patients the course was uneventful and an excellent outcome without significant neurological deficits (mRS ≤ 1) was achieved. Furthermore, the maternal outcome was not worse compared to the general population who underwent endovascular treatment of ruptured vascular brain lesions. Also, in most cases a healthy fetus was born. Conclusion: Endovascular treatment of ruptured cerebrovascular malformations during pregnancy is safe and feasible regarding both aspects, the maternal and fetal outcomes. Still, a stronger knowledge base is needed to correctly approach future cases of intracranial hemorrhage in the pregnant population.
AB - Purpose: Hemorrhagic stroke, particularly occurring from ruptured cerebrovascular malformations, is responsible for 5–12% of all maternal deaths during pregnancy and the puerperium. Whether endovascular treatment is feasible and safe for both the mother and the fetus, is still a matter of debate. The main objective of this case series and systematic review was to share our multi-institutional experience and to assess the feasibility and safety of endovascular treatment during pregnancy, as well as the corresponding maternal and fetal outcomes based on currently available evidence. Methods: We report a case series of 12 pregnant women presenting with hemorrhagic stroke from ruptured cerebrovascular arteriovenous malformations or aneurysms who underwent endovascular treatment prior to delivery. A systematic literature review of pregnant patients with endovascular treated cerebrovascular malformations, published between 1995 and 2022, was performed. Clinical patient information, detailed treatment strategies, maternal and fetal outcomes as well as information on the delivery were collected and assessed. Results: In most patients the course was uneventful and an excellent outcome without significant neurological deficits (mRS ≤ 1) was achieved. Furthermore, the maternal outcome was not worse compared to the general population who underwent endovascular treatment of ruptured vascular brain lesions. Also, in most cases a healthy fetus was born. Conclusion: Endovascular treatment of ruptured cerebrovascular malformations during pregnancy is safe and feasible regarding both aspects, the maternal and fetal outcomes. Still, a stronger knowledge base is needed to correctly approach future cases of intracranial hemorrhage in the pregnant population.
KW - Cerebral aneurysm
KW - Cerebrovascular arteriovenous malformation
KW - Cerebrovascular malformation
KW - Endovascular treatment
KW - Pregnancy
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U2 - 10.1007/s00062-023-01287-x
DO - 10.1007/s00062-023-01287-x
M3 - Article
C2 - 37256319
AN - SCOPUS:85160755960
SN - 1869-1439
VL - 33
SP - 833
EP - 842
JO - Clinical Neuroradiology
JF - Clinical Neuroradiology
IS - 3
ER -